疲惫不堪，努力应付——意大利伦巴第
本文译自：ESC官网
华中科技大学同济医学院附属协和医院 程翔 翻译并供稿
我们是一群在克雷马医院工作的心脏病专家。克雷玛（Crema）是米兰附近的一个古老的小城镇，成为电影“以你的名字呼唤我”的背景。距意大利的COVID-19疫情中心不到25公里。
我们已经成为首批面对这种紧急情况的医院之一，而COVID-19病人已使我们的医院陷入困境。自从紧急情况开始以来，我们面对的COVID-19住院患者数量呈指数增长。现在，我们可以算出大约100名住院患者，而且每天有60-80名新的COVID-19新患者来到急诊室。我们筋疲力尽，但我们不放弃。伦巴第（我们地区）的公共卫生服务被认为是意大利最好的，而意大利卫生服务被广泛认为是欧洲最好的公共服务之一。
最初，关于我们测试新冠状病毒的方法以及这些患者的治疗方法存在着巨大的争论。我们害怕被感染，但是在日常实践中，我们正在学习如何“识别”可疑患者，如何读取其CT扫描，对“简单”患者的治疗（严重者由肺科医生和麻醉师管理），也许更重要的是如何保护自己。 我们医院指示准备的一些方案可以在所有这些方面为我们提供帮助，或者至少可以尝试提供帮助！
在我们的医院中，已经建造了一个室外分诊帐篷，以便一旦有人到达，COVID-19疑似患者和非COVID-19的患者会走不同的路。等待上呼吸道检查结果的有症状患者在单人病房（可能的情况下），在原日间手术和直立病房以及部分急诊病房住院。确诊的COVID-19患者然后根据症状和需要的护理而被转移到不同的病房：需要机械通气的患者在ICU和由一些以前的手术室中转入ICU。需要高流量氧气无创通气的患者在CCU，呼吸科和耳鼻喉科病房，而稳定的患者在手术室和药物病房。
如您所见，医院已经改变了！ 包括外科手术和心脏手术在内的所有非紧急活动都被暂停，不仅在克雷马（Crema），而且在整个伦巴第地区都停止了，因为我们无法应付正常的日常活动以及紧急情况。在我们医院，只有心脏病学，神经病学和肿瘤学是无COVID-19病房的。 STEMI网络已在整个伦巴第进行了修改，为心脏病患者和COVID-19患者提供最佳治疗：救护车将STEMI患者转诊到COVID-19患者较少的中央医院（名为HUB），而周边SPOKE医院必须管理院内心脏紧急情况，为COVID患者节省人员，床位和能量。
每天，医生都会获取有关这种新疾病的新信息，并学会以最佳方式治疗患者。这是一项艰苦的工作，我们很累，有时甚至很难过，但我们知道，我们将共同赢得这场战争！
原文：
Exhausted and Trying to Cope – Lombardy, Italy
By Drs. Maurizio Landolina, Erika Taravelli and Valentina De Regibus
Cardiology Department, Crema Hospital
We are a group of cardiologists who work at the Hospital of Crema. Crema is a small, old town near Milan, which became a backdrop for the film “Call Me by Your Name”. It is less than 25 kilometres away from the Italian epicentre of the COVID-19 infection.
We have been one of the first hospitals to face this emergency and COVID-19 patients have swamped our Hospital. Since the beginning of this emergency, we are facing an exponential growth of hospitalised people with COVID-19. Now we can count around 100 hospitalized patients and we have around 60-80 new COVID-19 patients per day coming to the emergency. We are exhausted, but we don’t give up. Lombardy (our region) has a public health service that is considered the best in Italy, and the Italian health service is widely considered one of the best in Europe.
At the beginning, there was a huge debate about the way we test for the new coronavirus and the management of these patients. We were afraid of becoming infected, but day-by-day in our practice we are learning how to “recognise” suspected patients, how to read their CT scan, the therapy for the “easy” ones (the severe ones are managed by pulmonologists and anaesthesiologists) and, maybe even more important, how to protect ourselves. Several protocols prepared by our hospital direction help us in all these parts or at least try to help!
In our hospital an outdoor triage tent has been built so that once people arrive, COVID-19 suspected patients and non-COVID-19 patients travel different paths. Symptomatic patients waiting for the result of the upper respiratory tract tests are hospitalised in the former day-surgery and ortho wards and in part of the ER ward of course, in single (when possible) rooms. Confirmed COVID-19 patients are then moved to different wards depending on symptoms and need of care: patients requiring mechanical ventilation are in ICU and in some of the former operating rooms, transformed in ICU. Patients requiring high-flow oxygen non-invasive ventilation are in CCU, pneumology and otolaryngology wards, while stable patients are in surgery and medicine wards.
As you can see, the hospital has been transformed! Every non-urgent activity, including surgery and cardiac procedures, are suspended, not only here in Crema but in the whole Lombardy region, because we couldn't cope with the normal day routine plus this emergency. In our hospital only cardiology, part of neurology and part of oncology are COVID19-free wards. The STEMI network has been modified throughout Lombardy to provide the best therapy to both cardiac and COVID-19 patients: the ambulances are referring STEMI patients to central hospitals (named HUB) which have a low number of COVID-19 patients, while peripheral SPOKE hospitals have to manage in-hospital cardiac emergency, saving people, beds and energy for COVID patients.
Every day that goes by, physicians acquire new information about this new disease and learn to treat patients in the best way. It's a hard job, we are tired and sometimes sad but we know that all together, we will win this war!